title: Stillbirth classification in population-based data and role of fetal growth restriction: the example of RECODE.
abstract: BACKGROUND
  Stillbirth classifications use various strategies to synthesise information associated with fetal demise with the aim of identifying key causes for the death. RECODE is a hierarchical classification of death-related conditions, which grants a major place to fetal growth restriction (FGR). Our objective was to explore how placement of FGR in the hierarchy affected results from the classification.
  
  
  METHODS
  In the Rhône-Alpes region, all stillbirths were recorded in a local registry from 2000 to 2010 in three districts (N = 969). Small for gestational age (SGA) was defined as a birthweight below the 10th percentile. We applied RECODE and then modified the hierarchy, including FGR as the penultimate category (RECODE-R).
  
  
  RESULTS
  49.0% of stillbirths were SGA. From RECODE to RECODE-R, stillbirths attributable to FGR decreased from 38% to 14%, in favour of other related conditions. Nearly half of SGA stillbirths (49%) were reclassified. There was a non-significant tendency toward moderate SGA, singletons and full-term stillbirths to older mothers being reclassified.
  
  
  CONCLUSIONS
  The position of FGR in hierarchical stillbirth classification has a major impact on the first condition associated with stillbirth. RECODE-R calls less attention to monitoring SGA fetuses but illustrates the diversity of death-related conditions for small fetuses.
authors.affiliation: The RHEOP (Registre des Handicaps de l'Enfant et Observatoire Périnatal Isère, Savoie et Haute-Savoie), Grenoble, France. aego@chu-grenoble.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Ego
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
authors.forename: Pierre
authors.initials: P
authors.lastname: Batailler
authors.forename: Séverine
authors.initials: S
authors.lastname: Cornec
authors.forename: Anne
authors.initials: A
authors.lastname: Fondeur
authors.forename: Marion
authors.initials: M
authors.lastname: Baran-Marszak
authors.forename: Pierre-Simon
authors.initials: PS
authors.lastname: Jouk
authors.forename: Thierry
authors.initials: T
authors.lastname: Debillon
authors.forename: Christine
authors.initials: C
authors.lastname: Cans
mesh_terms: D000328:Adult; D001724:Birth Weight; D002423:Cause of Death; D005260:Female; D005313:Fetal Death / Q000145:classification* / Q000453:epidemiology / Q000209:etiology; D005317:Fetal Growth Retardation / Q000401:mortality*; D005602:France / Q000453:epidemiology; D006801:Humans; D007236:Infant, Small for Gestational Age; D008297:Male; D008423:Maternal Age; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth